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INTRODUCTION
Holding in a Relational Frame
Holding creates room. It establishes space in which experiences of self and other deepen. It supports a temporary illusion of attunement that buffers the sense of separateness. It helps us work effectively with patients who can't tolerate interpretation or relational dialogue. Particularly for our most vulnerable patients, holding facilitates the elaboration and management of emotional experience.
In this revised edition of Holding and Psychoanalysis, updated clinical material and four new chapters further expand and complicate this metaphor. Exploring the many forms that holding can take outside the realm of dependence, I theorize holding's clinical function and impact on both patient and analyst. As I detail holding's multiple clinical incarnations, theoretical underpinnings, and relational implications, I look at what the analyst does with herself as she tries to hold.
When difference is acutely threatening, the IāThou relatedness implicit in much analytic interchange is more disruptive than enriching. I invoke the holding metaphor to describe an emotionally protective space, co-constructed by analyst and patient, that facilitates interior exploration and supports an illusion of analytic attunement. Within this holding space, mutual relatedness is limited because the analyst privileges the patient's subjective process and actively struggles to bracket what would feel disjunctive. By bracketing (rather than expressing or deleting) she establishes a protective buffer against her otherness while sustaining access to her own experience.
Some patients can't easily contactāno matter exposeāprivate, disavowed, or dissociated aspects of self experience. Intense affects (e.g., anxiety, rage, longing, and so on) overwhelm; ordinary therapeutic interaction confronts the patient with the analyst's emotional responses, interpretations, or ideas about mutual enactments and shuts down rather than deepening the process. At these times, a therapeutic buffer that more or less protects the patient from the impact of our āothernessā (our separate subjecthood) can be clinically mutative.
I use the holding metaphor to invoke a dimension of analytic experience that sometimes coexists with active, intersubjective work and sometimes stands alone. Although an element of holding nearly always underlies analytic work, holding becomes pivotal when my patient is chronically derailed by evidence of my āothernessā and can't work with that experience of derailment. Her need for emotional resonance makes it near impossible for her to use my āseparateā understanding (expressed via both interpretation and other emotional communications), tolerate mutual exploration of our subjectivity (Aron, 1991, 1992), or actively negotiate around our experience of each other.
In Holding and Psychoanalysis I explore and expand holding's multiple functions, integrating the concept within a relational perspective by explicitly detailing holding's intersubjective aspect. Addressing the implicit dynamic meaning embedded in a holding stance, I explore a range of treatment situations where neither straightforward interpretation nor intersubjective interchange moves things forward.
This book bridges relational and object relational perspectives on the treatment process by spotlighting holding's relational edge. Relational theories privilege the intersubjective origins and dynamics of experience; they assume that both patient and analyst inform therapeutic interchange and emphasize its mutual, enacted element. Object relations theories (see, e.g., Fairbairn, 1952; Bowlby, 1969; Winnicott, 1958, 1965, 1971, 1989) focus on the developmental metaphor as it plays out in the analytic situation. They focus less on mutuality or reenactment than on therapeutic repair.
The object relations patient is a baby in need of reparative parenting while the relational patient is an adult who engages actively with the analyst in exploring the dynamics of clinical reenactments. The object relations analyst assesses the baby/patient's needs and responds to them; the relational analyst is far too implicated in clinical process to do this.
From a relational point of entrĆ©e, the idea of holding is inherently problematic: our omnipresent subjectivity makes it impossible for us to delete ourselves from analytic interchange or fluidly ābecomeā the needed other.
The (relational) holding function
Relational holding takes two. It's co-created by patient and analyst, whatever its affective color. It's sustained only when our patient joins us in maintaining a holding experience by (unconsciously) excluding (bracketing) those disturbing aspects of our āseparateā presence that leak through even when we try to hold.
So holding differs dramatically from āordinaryā therapeutic moments. In the latter, we use both our affectively resonant responses and more separate way of understanding: we introduce ourselves implicitly, if not directly. We try to expand our patient's awareness of the repetitive enacted element. But the introduction of our āseparateā understanding presents a special dilemma during moments of holding because our patient is too emotionally reactive to easily tolerate our input. It's felt to be too emotionally disjunctive, too āout of syncā with her experience. By introducing ourselves (our different ideas about what she's feeling and why), we disrupt (rather than deepen) her ability to contact, sustain, or elaborate on her own process. It's here that the holding illusion becomes central.
Within the holding moment, patient and analyst establish a temporary illusion of attunement that buffers the experience of separateness. While holding doesn't always preclude interpretive or intersubjective work, it narrows the range of what can be explored to what's conjunctive: we avoid introducing evidence of our emotional and/or cognitive otherness.
We hold when we struggle to more or less protect our patient from the derailing impact of our perspective. We try to sustain an emotionally contained space within which she's largely protected from disruptions; we don't challenge (or interpret) her experience or what she imagines we feel about her. Instead, we allow her illusion (whatever its shape) about us to remain intact. We do our best to contain (i.e., not express) those aspects of our reaction that feel distonic to her; in Winnicott's (1969) terms, we tolerate being subjectively perceived. This bounded space can facilitate a fuller elaboration of (disavowed or dissociated) aspects of self experience. In many treatments the impact of a holding experience can sooner or later be articulated, that is, integrated with meaning; more rarely, it cannot.
While traditional (Winnicottian) views of holding are organized around regression to dependence, I will unhook this tight association: in successive chapters I describe a range of difficult emotional states like rage, ruthlessness, and narcissistic self-involvement that may usefully be held. There's nothing soft about these kinds of holding; our capacity to hold is instead embodied in our emotionally alive recognition of our patient's affect state and in our capacity to recognize and tolerate it.
Holding isn't something we ādoā toāor forāour patients: the co-constructed holding experience reflects our struggle to contain our āseparateā perspective and our patient's participation in maintaining the holding illusion. Holding creates a protected space because it minimizes the danger of external intrusion (Winnicott, 1963b). By receiving her experience without changing its meaning and remaining emotionally present, a feeling of safety is sustained.
I'm spotlighting a treatment dimension that most often remains a backdrop to ordinary therapeutic interchange, especially within a relational framework. Yet it's my conviction that the holding theme is ubiquitous across psychoanalytic theories (though it's variously labeled). At times, it functions as the central therapeutic thread; at others it remains implicit. Holding is central in work with extremely vulnerable dependent, narcissistic, and borderline patients, but the holding theme represents a background element even in treatment contexts wherein a patient never requires an ongoing holding experience. It's ground when it's not figure; it's always there. We just often take it for granted.
How is holding different from the ordinary containment that's characteristic of every therapeutic situation? Don't we always work to contain aspects of our subjectivity because to do otherwise would represent major acting out? We do, but in ordinary therapeutic moments we also make indirect use of our reactions via questions, reflective and interpretive statements. And often to good effect: both our ideas about dynamic process and indirect expressions of countertransference move the process forward. They also help us: by creating and communicating meaning, we get a chance to use ourselves, experience our own competence, clarify (and perhaps shift) our reactions.
Interpretations and other expressions of our subjectivity provide a vehicle through which we can think about our emotional reactions (and sometimes moderate them). By linking our experience with the material and then organizing these links into communicable ideas, we diffuse and connect affect and thought (Bion, 1962; Jacobs, 1994). But relatively little of this happens during moments of holding. Unable to make explicit use of ourselves, it's harder to regulate our affect state. Even if we continue to think or interpret silently, we're under intensified strain because we're constrained from explicitly addressing or expressing what we're feeling and thinking. Our capacity to hold ourselves while we're trying to hold our patient will be crucial to holding's therapeutic effect.
As I explore the variegated forms and dynamic shapes of different holding experiences, I systematically examine patient and analyst's separate and joint contributions to them. Inevitably, these vary enormously; they're reflective of our patient's particular needs and our personal way of assimilating and reacting to them.
Holding and interpretation
Can a holding process occur simultaneously with an interpretive one, or are the two functions mutually exclusive? To the extent that interpretations derive from our separate understanding of our patient's process, they're likely to disrupt the holding experience. When our patient is chronically derailed by the evidence of our otherness (that's reflected in our interpretations) and isn't able to examine it, she's more likely to simply live it out. Here, holding creates a relatively thick protective buffer against derailment.
But the holding function doesn't exist outside the realm of the metaphoric. Holding itself sometimes functions as a symbolic container. The holding experience also embodies its own implicit communication and in a sense represents an unspoken (enacted) interpretation (e.g., āI can remain with you, understand you, tolerate your angerā and so on). This kind of background interpretative action (Ogden, 1994) doesn't require an explicit response or acknowledgment on the patient's part. And at times, interpretations and holding occur side by side because of our patient's capacity to feel held by an interpretation (Winnicott, 1972; Pine, 1984).
Holding as the red thread
The holding metaphor developed out of Winnicott's association between psychoanalysis and the mother-infant relationship. It's connected with a highly idealized, protective analytic stance. The Winnicottian analyst held the very vulnerable patient in order to protect her from noxious environmental impingements while she contacted previously hidden aspects of true self experience (Winnicott, 1960b). To the degree that the analytic holding function is based on the parents' even responsiveness to their infant, the patient who needed a holding experience was viewed to be struggling with the dependency needs characteristic of infancy.
In Holding and Psychoanalysis, however, I unlink holding and dependency. I describe moments of holding that occur when we're functioning in anything but an idealized way, when what's held isn't dependence but a variety of other difficult affect states like self-involvement, ruthlessness, or rage. These statesāand people's need for moments of holdingāpervade the life span. Holding thus engages a far more complex set of analytic functions than those associated with an idealized view of infancy and the maternal role. We hold in multiple emotional situations by providing our patient with a containing and relatively even emotional space within which to experience and express a range of difficult affect states. We hold by tolerating, more or less unexpressed, our sometimes intense reactions to her communications.
I'm using the word holding to describe a double clinical function that involves our way of working with a patient and with ourselves. That double function organizes around our attempt to function more as a container than as an actor within the psychoanalytic dyad. More about this in Chapter 2.
Holding and trauma
The need for holding often reflects early damage or deprivation; our most reactive and vulnerable patients were profoundly traumatized. By holding, we offer our patient a reparative experience that, with time, will allow our patient to contact, re-experience, and move beyond the original āfailure situationā (Winnicott, 1955ā1956).
But early trauma isn't the single precondition for the need for holding. Reactivity to emotional impingement can reflect failures of recognition in Benjamin's sense (1988, 1995) across the entire developmental (and adult) trajectory. When the other's āothernessā is felt to obliterate, negate, or otherwise disrupt the sense of āgoing on being,ā our very separateness embodies an omnipresent threat. Sensitivity to disruption is intensified in the treatment situation because of a breakdown of the usual protective barriers with which the adult defends against experiencing the other's simultaneous emotional power and separateness.
To what degree is holding a momentary or transient experience? Do patients move from moments of holding to moments of intersubjective work, or does analytic process evolve from prolonged periods of holding into fully intersubjective exchange? Or both?
Virtually any successful therapeutic process includes interpretive and explorative work, along with enactments of many kinds that eventually yield to understanding. But nearly every treatment also involves moments of holding even when a more prolonged holding experience is absent. In some treatment situations, a longer holding experience is needed, and it's here that I'll focus: they best illustrate holding's complex dynamics and allow for a āclose textā study of their impact and consequences. But even though the transient...
